Diabetic Ketoacidosis
Diabetic ketoacidosis, or DKA, can be a little hard to get your head around. I would recommend leaning a little about how insulin works during normal healthy regulation, and developing an understanding of type one diabetes before you try to tackle it (see videos on the diabetes home page). If you get the basics down first then its really not so complicated.
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Watch my animated video on Ketoacidosis here.
1. Mechanisms leading to Diabetic Ketoacidosis
Insulin is a vital hormone for the regulation of glucose
Who's at Risk??
Common causes of DKA
Diabetic Ketoacidosis occurs when the body doesn't have enough insulin to meet it's needs.
DKA predominantly effects suffers of type one diabetes. (Sufferers of type two normally secrete enough insulin into their blood to prevent DKA from getting going, however this is not always true so be vigilant!)
In type-one diabetes, the sufferer's pancreas has lost the ability to produce and secrete insulin. Unless they receive insulin via another means (eg. an injection) then DKA will eventually occur. Common cause of DKA include,
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New onset type one diabetes- Often type one diabetes is first diagnosed when the individual develops signs of DKA.
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Not taking insulin- There are many reasons why someone might not take their insulin. An individual admitted to hospital might find them selves dependent on others to administer their medications. Some suffers may be reluctant to take their insulin through a fear of hypo's.
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Not taking enough insulin- Insulin requirements can vary over time. For example, someone suffering from sepsis might find that metabolic activity in their body increases as they attempt to fight off the infection. Increased metabolic activity will require more glucose to fuel it, which in turn will mean the body needs more insulin to regulate that glucose... If the sufferer doesn't increase the amount of insulin they administer to match then DKA could begin to manifest!
Do we really need insulin? (yes we do...)
To understand the consequences of 'not enough insulin' we need to understand the role that insulin actually plays for our bodies. There is a page on this website (+ a video) dedicated to this topic, so you might want to start there. Otherwise let's recap quickly now.
Insulin 'the key'
Our cells need the glucose that's floating around in our blood to make ATP (energy). But the glucose can't pass through the cell walls without help! Insulin is the hormone that 'unlocks' the cell. when insulin interacts with a cell wall it becomes permeable to glucose, allowing the glucose inside the cell where the mitochondria can make use of it for energy.
No insulin?
If there's no insulin available then the cells will need another source of energy, and that alternative source of energy comes with complications (ketones...).
Dealing with 'excess' glucose
We need some glucose floating around in our blood for energy, however to much excess glucose leads to all sorts of problems! Insulin is the hormone responsible for tidying away excess blood glucose. Insulin drives the uptake of glucose into the liver and muscle cells where it's stored for later use.
No insulin?
then the glucose in our blood will have no where to go! Blood sugars levels will begin to go up!
THIS SECTION IS A WORK IN PROGRESS! come back soon and hopefully it will be finished....
Oversimplified
Diabetic Ketoacidosis (DKA) essential comes around when the body doesn't have enough Insulin to effectively regulate the bodies blood glucose. For example, when a suffer of type one diabetes doesn't take their insulin.
To much glucose in the blood
Without insulin the glucose we take in form our diets can't be used. Its not taken into cells for energy, and its not taken into the liver for storage. Instead it builds up in the blood.
High blood glucose concentrations act a but like a magnet for fluids. They draw fluids out of cells, into the blood. This fluid is passed out of the body as urine leaving the suffer dehydrated, thirsty and hypotensive!
Diabetic Ketoacidosis (DKA) explained with cartoons!
Ketones
If the body can't use glucose for energy it will need another source of energy. The body therefore starts to break down fat to produce ketones. Ketones can be an effective energy source and can keep the body going, but there's a catch, there acidic! In DKA the body produces so many ketones that this becomes a problem. Acidosis leads to;
-blood vessels dilating: the suffers becomes ever more hypotensive and starts to loose heat (becoming hypothermic) as more blood flows to the skin.
- As things develops the bodies enzymes will find it too acidic to operate. The cells will slow down and will eventually cease to be able to operate.